In the 50-center international CURE study, diagnosis was delayed in 24.4% of the patients by at least a year. Pavel Kolkhir, MD, study lead and head of the chronic urticaria program in the Institute of Allergology at Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin in Berlin, Germany, said, \u201cAnd 1 in 10 patients waited longer than 3\u2009years to be diagnosed.\u201d<\/p>\n
The study was published in Clinical & Experimental Allergy<\/em>.<\/p>\n Reasons for delayed diagnosis included low awareness of urticaria guidelines and rare or difficult-to-diagnose disease forms such as vibratory angioedema, Kolkhir and colleagues noted.<\/p>\n In addition, lack of devices to diagnose inducible urticaria, difficulties with differential diagnosis, and low urticaria activity are other potential factors.<\/p>\n Chronic urticaria is a debilitating disease characterized by recurrent itchy hives and wheals and\/or angioedema whose pathogenesis depends on the release of histamine by mast cell activation. Diagnosis includes clinical history and physical examination, but atypical presentations or misdiagnosis can lead to diagnostic delay.<\/p>\n Unfortunately, commented Myron J. Zitt, MD, an allergist-immunologist in Long Island, New York, \u201cAs allergists, we\u2019re seeing more chronic urticaria in clinical practice. The condition is underrecognized and the serious impact it has on quality of life is not appreciated.\u201d Zitt is also a clinical professor of medicine at State University of New York at Stony Brook.<\/p>\n Chronic urticaria affects about 2%-3% of the general population with consistently increasing global prevalence, Kolkhir said. \u201c<\/em>The rise is likely driven by a combination of environmental changes, lifestyle factors, autoimmune dysfunction, and increased recognition of the condition.\u201d<\/p>\n Chronic urticaria can be triggered by cold, heat, alcohol, spicy food, stress, scratching, and exercise, among other factors.<\/p>\n In terms of the US, one report has estimated chronic urticaria prevalence in more than 500,000 adults (230 cases per 100,000 adults). Prevalence is higher in women (310 cases per 100,000 adults) and in individuals aged 40-59 years (251 cases per 100,000 adults). The higher female prevalence, said Zitt, is partly due to hormonal influences. \u201cEstrogen acts on the receptors on mast cells resulting in an overly strong response to histamine.\u201d<\/p>\n \u201cProgesterone can also have an impact, and some women experience flares before or during their periods,\u201d he added. Some affected women also have rheumatoid arthritis or autoimmune hypothyroidism.<\/p>\n The ongoing CURE study retrospectively analyzed data from 4332 adults, of whom 61% had standalone chronic spontaneous urticaria (sCSU), 18% had at least one form of inducible chronic urticaria (CIndU), and 21% had a combination of both (CSU + CIndU).<\/p>\n Patients with CIndU experienced a longer delay to diagnosis than those with sCSU or CSU + CIndU. Those with CIndU had a median delay of 4 months (IQR, 0-2 months), while the other two CU groups had median delays of 1 month (IQR, 0-6) and 2 months (IQR, 0-90), respectively (P\u00a0<\/em>< .001).<\/p>\n Among patients with CIndU, those with symptomatic dermographism (n = 264) and cholinergic urticaria (n = 103) had the longest diagnostic delays (median, 4 months; P\u00a0<\/em>= .005 for both). In patients with CIndU, longer delay was associated with having an additional induction factor (odds ratio, 12.8; P\u00a0<\/em>= .03), younger age, comorbidities, lower disease control, and no use of nonsedating second-generation H1 antihistamines.<\/p>\n In patients with CSU, a diagnostic delay of 6 months or more was associated with lower CSU activity \u2014 a median weekly urticaria activity score of 14 vs 21 (P\u00a0<\/em>= .02).<\/p>\n \u201cWhile other skin diseases that also present with wheals and\/or angioedema can be misdiagnosed as [chronic urticaria], the main differential diagnosis of [chronic urticaria] includes urticarial vasculitis and autoinflammatory syndromes.Key differentiators are wheals lasting more than 24 hours, pain or bruising instead of itching, and systemic symptoms like fever or joint pain,\u201d Kolkhir noted.<\/p>\n Physicians are frequently unaware of urticaria guidelines; inappropriately counsel patients; and often prescribe first-generation sedating antihistamines, on-demand treatment only, or prolonged use of systemic corticosteroids, the authors noted.<\/p>\n Consequently, patients fail to improve, develop side effects, and stop treatments. Some surveys have shown that more than 50% of the patients are not even seeking medical care. \u201cIt\u2019s amazing how many doctors are still treating chronic urticaria with Benadryl, which only lasts 4 hours and is sedating,\u201d Zitt said.<\/p>\n \u201cEducation should aim to help primary care physicians distinguish between CSU and CIndU as CIndU often has longer diagnostic delays,\u201d said Kolkhir. In addition, training on validated tools such as the urticaria control test to assess disease management is advisable.<\/p>\n \u201cTraining should also focus on when to refer to specialists, particularly if symptoms persist despite high-dose antihistamines,\u201d he said.\u00a0<\/p>\n Zitt noted that injectable biologics such as omalizumab (Xolair) and dupilumab (Dupixent), as well as the new oral selective small-molecule Bruton tyrosine kinase inhibitor remibrutinib (Rhapsido), are available when high doses (up to four times daily) of second-generation antihistamines fail.\u00a0<\/p>\n \u201cAnd other new agents are coming down the pike or are already waiting to be approved.\u201d In the meantime, he recommends using the recently updated European chronic urticaria guidelines.<\/p>\n \u201cCURE-based evidence shows that diagnostic delay is common yet largely preventable,\u201d said Kolkhir. Clinicians can shorten the patient journey by recognizing chronic urticaria early, limiting unnecessary investigations, initiating guideline\u2011directed therapy without delay, and ensuring timely referral when control is inadequate, he added.<\/p>\n This study received no specific funding. Kolkir reported having been a speaker, consultant, and\/or adviser for and having received research funding from BioCryst, Merus, Novartis, Sanofi, ValenzaBio, and Roche outside of the submitted work. Numerous co-authors reported multiple ties to various pharmaceutical companies. Zitt reported having no relevant competing interests to disclose.<\/em><\/p>\n<\/div>\n In the 50-center international CURE study, diagnosis was delayed in 24.4% of the patients by at least a year. Pavel Kolkhir, MD, study lead and head of the chronic urticaria program in the Institute of Allergology at Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin in Berlin, Germany, said, \u201cAnd 1 in 10 patients waited longer than 3\u2009years to […]<\/p>\n","protected":false},"author":1,"featured_media":14929,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_daextam_enable_autolinks":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[2],"tags":[],"class_list":["post-14928","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/diyhaven858.wasmer.app\/wp-content\/uploads\/2026\/01\/gty-260129-hives-urticaria-800x450.jpg","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts\/14928","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/comments?post=14928"}],"version-history":[{"count":0,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts\/14928\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/media\/14929"}],"wp:attachment":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/media?parent=14928"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/categories?post=14928"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/tags?post=14928"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"photo](\"https:\/\/img.medscapestatic.com\/vim\/live\/professional_assets\/medscape\/images\/thumbnail_library\/ht-260129-pavel-kolkhir-120x156.jpg\")
Epidemiology<\/h2>\n
Study Details<\/h2>\n
Remedies<\/h2>\n
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<<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"